Johnson M P, Bukowski T P, Reitleman C, Isada N B, Pryde P G, Evans M I
Department of Obstetrics and Gynecology, Hutzel Hospital, Detroit, MI 48201.
Am J Obstet Gynecol. 1994 Jun;170(6):1770-6; discussion 1776-9. doi: 10.1016/s0002-9378(94)70353-1.
We present a new approach to prenatal evaluation and prediction of renal function and long-term outcomes for fetuses considered candidates for in utero surgery.
A review of 34 cases of obstructive uropathies was made, with analysis of our approach to prenatal evaluation, the predictive value of urinary electrolytes and protein analysis in identifying renal dysplasia, and the outcomes of cases with and without in utero surgical intervention.
Ten of 11 pregnancies that were terminated had dysplasia; one female had cloacal dysgenesis. In three of eight unshunted cases megacystis resolved after vesicocentesis. Eight of 15 shunted fetuses survived. Of those predicted to have good postnatal outcome, six of six demonstrated good postnatal renal function. Of those predicted to have poor outcomes, two of two had poor postnatal renal function and dysplasia. Seven of 15 shunted fetuses died, four of four predicted to have dysplasia were confirmed, and three died of nonrenal causes.
Our prenatal approach successfully differentiated fetuses with underlying renal dysplasia from those without irreversible damage who subsequently benefited from in utero vesicoamniotic shunt placement.
我们提出一种新方法，用于对被视为宫内手术候选胎儿的肾功能及长期预后进行产前评估和预测。
回顾了34例梗阻性尿路病病例，分析我们的产前评估方法、尿电解质及蛋白质分析在识别肾发育异常中的预测价值，以及有或无宫内手术干预病例的预后情况。
11例终止妊娠的胎儿中有10例存在发育异常；1例女性有泄殖腔发育不全。8例未分流的病例中，3例在膀胱穿刺术后巨大膀胱消失。15例分流胎儿中有8例存活。在预计产后预后良好的胎儿中，6例中有6例产后肾功能良好。在预计预后不良的胎儿中，2例中有2例产后肾功能不良且存在发育异常。15例分流胎儿中有7例死亡，预计有发育异常的4例中有4例得到证实，3例死于非肾脏原因。
我们的产前方法成功地将存在潜在肾发育异常的胎儿与无不可逆损伤、随后受益于宫内膀胱羊膜分流术的胎儿区分开来。
